Telehealth and Peptide Therapy Informed Consent
Hayat. Clinical services provided by Allarakhia M.D., P.C..
This document explains how care is provided through Hayat and asks for your consent to receive care by telehealth and, where prescribed, to be treated with peptide and related therapies, including compounded medications. Please read it before your first visit.
1. What telehealth is
Telehealth is the delivery of healthcare using secure electronic technology, which may include video, phone, and messaging, without an in-person visit. A licensed clinician will review your information, evaluate you, and provide care remotely.
2. Benefits and limitations
Telehealth offers convenient and timely access to care. It also has limits. A remote evaluation may not be appropriate for every condition, and your clinician may recommend or require an in-person visit, additional testing, or a referral before making certain decisions.
3. Technology and privacy risks
Connections may fail or be interrupted, and information transmitted electronically carries some privacy and security risk despite the safeguards we use. If a visit cannot be completed, your clinician will arrange an alternative. Your information is protected as described in our Notice of Privacy Practices.
4. Clinical discretion and alternatives
A licensed clinician will evaluate you and may decline to prescribe or treat if it is not clinically appropriate. You may seek in-person care at any time, decline any recommended treatment, and ask questions about alternatives, including no treatment.
5. Compounded medications
Some therapies offered through Hayat are compounded medications prepared for you by a state-licensed compounding pharmacy under an individual prescription. You should understand the following before consenting.
Compounded medications are not FDA-approved. The FDA does not review compounded drugs for safety, effectiveness, or quality before they are dispensed. Compounding is a lawful, regulated practice, but the finished compounded product itself has not gone through the FDA approval process.
For some conditions, an FDA-approved alternative may exist. Your clinician will discuss available options with you where relevant.
6. Peptide and related therapies
Therapies available through Hayat may include, depending on clinical appropriateness and availability: GLP-1 medications for weight management, topical and injectable peptides such as GHK-Cu, PT-141 (bremelanotide), NAD+, L-carnitine, tretinoin, oxytocin, and hCG. Not every therapy is available to every patient, and availability may change.
Some of these therapies are prescribed off-label, meaning for a use other than the one the FDA approved, or in a form other than the approved form. Off-label prescribing is a lawful and common part of medical practice, but it means the specific use has not been established through the FDA approval process. For some peptide therapies, long-term safety and effectiveness data in humans are limited. Your clinician will explain what is and is not known about any therapy recommended to you.
7. Risks and side effects
All medications carry risk. Common risks of injectable therapies include pain, redness, or swelling at the injection site and allergic reaction, which can rarely be severe. GLP-1 medications commonly cause nausea, vomiting, constipation, or diarrhea, and carry warnings that include pancreatitis, gallbladder disease, and, for some agents, thyroid C-cell tumors observed in rodents. These medications should not be used during pregnancy. Other therapies carry their own risks, which your clinician will review with you before prescribing. You agree to report side effects promptly and to stop a therapy and seek care if directed.
8. Laboratory testing and monitoring
Some therapies require baseline and ongoing laboratory testing. You agree to complete testing your clinician orders. Declining required monitoring may mean a therapy cannot be started or continued safely.
9. Prescriptions and pharmacy
If a prescription is appropriate, it is issued at the clinician's discretion and filled by a licensed partner pharmacy. Controlled substances are not prescribed through Hayat's telehealth service. [Confirm and revise if testosterone or any controlled substance enters scope.]
10. Emergencies
Telehealth is not for emergencies. If you have a medical emergency, call 911 or go to the nearest emergency room.
11. Your consent
You may withdraw this consent at any time, except with respect to care already provided. By signing below, you confirm that you have read this document, had the chance to ask questions, and consent to receive care by telehealth and to be treated with the therapies described above where prescribed for you.